Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients

Linda Larkey, Darya McClain, Denise J. Roe, Richard D. Hector, Ana Maria Lopez, Brian Sillanpaa, Julie Gonzalez

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose. Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening. Design. A two-group parallel randomized controlled trial. Setting. Primary care, safety-net clinics. Subjects. Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish. Intervention. Patients were exposed to either a video created from personal stories composited into a drama about "Papa" receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence. Measures. Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior. Analysis. Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models. Results. Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37% and 42% screened for storytelling and risk-based messages, respectively; n 539; 33.6% male; 62% Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening. Conclusion. A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both intervention's engagement factor facilitated positive attitudes about CRC screening associated with behavior change.

Original languageEnglish (US)
Pages (from-to)e59-e70
JournalAmerican Journal of Health Promotion
Volume30
Issue number2
DOIs
StatePublished - Nov 1 2015

Fingerprint

Early Detection of Cancer
Colorectal Neoplasms
cancer
low income
Randomized Controlled Trials
Hispanic Americans
Primary Health Care
Safety-net Providers
speaking
Drama
Colonoscopy
Poverty
Health Insurance
Insurance
Health Promotion
path analysis
Health Personnel
demographic factors
health insurance
drama

Keywords

  • Colorectal Cancer Screening, Narrative, Storytelling, Cancer Risk, Prevention Research. Manuscript format: research
  • Health focus: medical self-care
  • Outcome measures: behavioral
  • Research purpose: intervention and model testing
  • Setting: clinical/health care
  • Strategy: education
  • Study design: randomized trial
  • Target population age: adults
  • Target population circumstances: low-income, minority, Southwestern United States

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health

Cite this

Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients. / Larkey, Linda; McClain, Darya; Roe, Denise J.; Hector, Richard D.; Lopez, Ana Maria; Sillanpaa, Brian; Gonzalez, Julie.

In: American Journal of Health Promotion, Vol. 30, No. 2, 01.11.2015, p. e59-e70.

Research output: Contribution to journalArticle

Larkey, Linda ; McClain, Darya ; Roe, Denise J. ; Hector, Richard D. ; Lopez, Ana Maria ; Sillanpaa, Brian ; Gonzalez, Julie. / Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients. In: American Journal of Health Promotion. 2015 ; Vol. 30, No. 2. pp. e59-e70.
@article{f3946200527b452c8deece6356e2e84e,
title = "Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients",
abstract = "Purpose. Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening. Design. A two-group parallel randomized controlled trial. Setting. Primary care, safety-net clinics. Subjects. Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish. Intervention. Patients were exposed to either a video created from personal stories composited into a drama about {"}Papa{"} receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence. Measures. Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior. Analysis. Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models. Results. Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37{\%} and 42{\%} screened for storytelling and risk-based messages, respectively; n 539; 33.6{\%} male; 62{\%} Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening. Conclusion. A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both intervention's engagement factor facilitated positive attitudes about CRC screening associated with behavior change.",
keywords = "Colorectal Cancer Screening, Narrative, Storytelling, Cancer Risk, Prevention Research. Manuscript format: research, Health focus: medical self-care, Outcome measures: behavioral, Research purpose: intervention and model testing, Setting: clinical/health care, Strategy: education, Study design: randomized trial, Target population age: adults, Target population circumstances: low-income, minority, Southwestern United States",
author = "Linda Larkey and Darya McClain and Roe, {Denise J.} and Hector, {Richard D.} and Lopez, {Ana Maria} and Brian Sillanpaa and Julie Gonzalez",
year = "2015",
month = "11",
day = "1",
doi = "10.4278/ajhp.131111-QUAN-572",
language = "English (US)",
volume = "30",
pages = "e59--e70",
journal = "American Journal of Health Promotion",
issn = "0890-1171",
publisher = "American Journal of Health Promotion",
number = "2",

}

TY - JOUR

T1 - Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients

AU - Larkey, Linda

AU - McClain, Darya

AU - Roe, Denise J.

AU - Hector, Richard D.

AU - Lopez, Ana Maria

AU - Sillanpaa, Brian

AU - Gonzalez, Julie

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Purpose. Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening. Design. A two-group parallel randomized controlled trial. Setting. Primary care, safety-net clinics. Subjects. Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish. Intervention. Patients were exposed to either a video created from personal stories composited into a drama about "Papa" receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence. Measures. Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior. Analysis. Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models. Results. Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37% and 42% screened for storytelling and risk-based messages, respectively; n 539; 33.6% male; 62% Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening. Conclusion. A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both intervention's engagement factor facilitated positive attitudes about CRC screening associated with behavior change.

AB - Purpose. Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening. Design. A two-group parallel randomized controlled trial. Setting. Primary care, safety-net clinics. Subjects. Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish. Intervention. Patients were exposed to either a video created from personal stories composited into a drama about "Papa" receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence. Measures. Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior. Analysis. Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models. Results. Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37% and 42% screened for storytelling and risk-based messages, respectively; n 539; 33.6% male; 62% Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening. Conclusion. A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both intervention's engagement factor facilitated positive attitudes about CRC screening associated with behavior change.

KW - Colorectal Cancer Screening, Narrative, Storytelling, Cancer Risk, Prevention Research. Manuscript format: research

KW - Health focus: medical self-care

KW - Outcome measures: behavioral

KW - Research purpose: intervention and model testing

KW - Setting: clinical/health care

KW - Strategy: education

KW - Study design: randomized trial

KW - Target population age: adults

KW - Target population circumstances: low-income, minority, Southwestern United States

UR - http://www.scopus.com/inward/record.url?scp=85000580259&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85000580259&partnerID=8YFLogxK

U2 - 10.4278/ajhp.131111-QUAN-572

DO - 10.4278/ajhp.131111-QUAN-572

M3 - Article

C2 - 25615708

AN - SCOPUS:85000580259

VL - 30

SP - e59-e70

JO - American Journal of Health Promotion

JF - American Journal of Health Promotion

SN - 0890-1171

IS - 2

ER -